DISORDERS OF GASTORINTESTINAL TRACT WITH ACUTE NECROTIZING PANCREATITIS

Abstract

Objective: to establish changes of intestinal functions, including absorbing and metabolic, and their influence on complications development during phases of acute necrotizing pancreatitis. Material and methods. A prospective observational cohort study of 151 patients with acute necrotizing pancreatitis which were admitted to intensive care department was conducted. Severity of intestinal dysfunction was determined according to European Society of Intensive Care Medicine (ESICM) Recommendations. Clinical and laboratory changes as well as plasma citrulline concentrations were studied. Results and discussion. Disorders of gastrointestinal functions of 1st grade were found in 17.9%, 2nd grade – 29.1%, 3rd grade – 31.7%, 4th grade – 8.6% of patients with acute necrotizing pancreatitis. Serum citrulline concentration below 12.5 µmol/l enabled to diagnose development of intestinal failure. It was established by multivariate logistic regression that respiratory, cardio-vascular, renal and intestinal failure were independent mortality factors. Conclusions: Disorders of gastrointestinal functions in 35.8% of patients with acute necrotizing pancreatitis are represented by feeding intolerance, in 33.2% - by intestinal failure. Plasma citrulline concentration enables to diagnose development of intestinal failure with high sensitivity and specificity.